Knee Replacement Results Improved By Computer Navigation

Posted on June 19, 2015.

For Immediate Release CONTACT: Amanda Maselli New Hampshire Orthopaedic Center 603.883.0091 nhoc.com   KNEE REPLACEMENT … Read More

Dr. Sinkov – On Call with the NH Medical Society

Posted on May 15, 2015.

If you weren’t able to catch Dr. Sinkov’s May 13th ‘On Call with the NH Medical … Read More

We Made New Hampshire Magazine’s ‘Top Doc’ List for 2015!

Posted on March 20, 2015.

We are proud to be included in New Hampshire Magazine’s Top Doctors for 2014!  Congratulations … Read More

New Hampshire Orthopaedic Center

Afraid to Have A Knee Replacement? You Are Not Alone

Posted on July 16, 2015.

By: Kathleen A. Hogan, MD

Each year, over 700,000 total knee replacements are performed per year in the United States. Many people who have arthritis can have pain relief with non-operative treatments such as weight loss, braces, activity modification, medications, and injections. But when these treatments are no longer effective, joint replacement is often recommended. However, some people delay or avoid surgery, despite being in pain.

Common Reasons People Are Afraid to Have a Knee Replacement

There are some common reasons that people are afraid to have a knee replacement. Fear of pain is usually the top reason. Concerns about missing work or important events is the second most cited reason to delay surgery. Some people feel they are too old for surgery. Others worry about complications of the procedure.

Managing Pain

Knee replacement is a painful procedure. Bones are covered with a thin layer of tissue called periosteum which contains nerve fibers. During a knee replacement, the bones are cut and this causes a painful inflammatory response. To prevent pain, the best treatment is to be proactive. For example, my patients usually take an anti-inflammatory medication 3 days prior to surgery. A nerve block is given before the surgery and local anesthestic agents are placed within the joint during the surgery. Some medications, such as tylenol and toradol are given around the clock after surgery, and narcotic pain relievers provide additional relief as needed. This multi-modal pain regimen provides excellent relief of pain, but the knee will still be stiff and sore. The pain is at its worst during the first few days after the surgery and then improves.

Returning to Work

Returning to work after surgery is dependent on the requirements of the job. However the first 2-4 weeks you should concentrate on feeling better and working with physical therapy. If your job does not require much standing, lifting, or climbing, you may be able to go back to work in 6 wks; more strenuous jobs will require more time off. Everyone is different in regards to how long it takes to return to work.

How Old is Too Old?

How old is too old for a new joint replacement? So far, insurance companies have not denied patients joint replacements based solely on their age. A healthy 90 year old may have a longer life expectancy than a 60 year old diabetic with heart disease who smokes. Recommendations for or against surgery should be based on your health and the amount of arthritis in your joint, not on just your age.

Surgical Complications

What about complications? No surgery is without some risk. The majority of people who have knee replacement surgery are very pleased with the outcome and many wish they had chosen to have the surgery sooner. Occasionally, complications such as medical problems (pneumonia, heart attack, blood clots), stiffness of the joint, continued knee pain, implant loosening, implant failure, and infection can occur. However, these complications are rare and over 90% of people are very satisfied with their new knees. Certain activities, such as running are not recommended because of the risk of premature wear and loosening of the implant. Less than 1% of knee surgeries are complicated by infection, but infections can also spread from elsewhere in the body to the metal joint, so prophlaytic antibiotics are sometimes recommended before dental and other medical procedures.

Ask Your Surgeon Questions

If you have been told that you need to have a knee replacement do not be afraid to ask questions. Have you tried all the non operative treatments for arthritis? Are their any options other than surgery? Make sure you are comfortable with the surgeon who will be performing your knee replacement. You should be able to talk to your surgeons about your concerns and fears about joint replacement.

Don’t let fear keep you from doing the things you enjoy in life.

The Evolution of Joint Replacements

Posted on July 7, 2015.

by: Douglas M. Joseph, MD

This year, about 800,000 people in the US will have either a hip or knee replacement. Total hip and knee “survival” or success is estimated by The Academy of Orthopaedic Surgery to be greater than 90% in several twenty-five year follow up studies.

The Evolution of Joint Replacements

We’ve come along way since 1963 when John Charnley, MD started the Total Hip Joint Replacement era when his article titled Low Friction Arthroplasty was published in the British Medical Journal The Lancet. For this work, Dr. Charnley was later knighted by the Queen of England.  

About ten years later at the Hospital for Special Surgery in New York City,  John Insall, MD and Chitranhan Ranawat, MD collaborated on the development of the Total Knee Replacement, as reported in the Journal of Bone and Joint Surgery in 1974.   

We pass on these landmark articles to you to inform you about the historic start of two procedures that have changed the lives of so many patients suffering from hip and knee arthritis.  

Design changes over the years have improved our long term results. No longer is it true that these procedures “only last for ten years.” That was true back in the 1980’s but is now incorrect.  

New Hampshire Orthopaedic Center’s Total Joint Team

We here in the total joint team at New Hampshire Orthopaedic Center specialize in these procedures. We are fellowship trained and keep up with the latest developments in our ever-changing field. You can be confident that you will have the very best care and success when you have your hip or knee replaced by one of our excellent surgeons.   

This month’s journal is dedicated to you, our patients. We want to highlight articles on the American Academy of Orthopaedic Surgeons website that will help you understand the hip and knee replacement procedures you may need to eliminate your pain. 


As we say here at the New Hampshire Orthopaedic Center, “We Keep Bodies In Motion.” 

Resources

American Academy of Orthopaedic Surgeons OrthoInfo: 

Total Hip Replacement

Total Knee Replacement

Return to Golf and Tennis After Joint Replacement 

Posted on June 18, 2015.

By: Kathleen A. Hogan, MD

As the last of the snow melts away, thoughts turn away from the ski slopes and towards the golf course and the tennis courts.    Unfortunately, if you have been living with hip or knee pain, these recreational activities may be more painful than pleasurable.    

As a joint replacement surgeon, I treat patients whose pain from arthritis keeps them from participating in activities that they enjoy.  When non-operative treatments no longer provide significant pain relief, joint replacement may be an option.  Hip and knee replacement can be extremely successful in relieving pain from daily activities such as walking, standing, and stair climbing.  But for some people, this is not enough.   They want to get back to playing sports. This article will explore the issues affecting a return to golf and tennis after joint replacement. 

Impact of Activity on an Artificial Joint

Joint replacements can wear out, and high impact activities such as running may cause the artificial joint to wear out faster, possibly leading to further surgery.  However, most joint replacement surgeons allow their patients to resume moderate activity, including golf and doubles tennis.   Golf and tennis do place considerable stresses on the knee with joint reactive forces similar to jogging generated during the swing of a racket or club.   In golf, the leading knee absorbs the most stress, and in tennis the forehand puts more stress on the knees than does a backhand stroke.

Return to Sporting Activity

Return to sporting activity depends on the type of joint replaced. Recovery after a hip replacement is typically faster than after knee replacement.   The direct anterior approach to hip replacement limits muscle damage and speeds recovery.  However, the bone needs to grow into the implant to stabilize it, and I recommend waiting a minimum of 8 weeks before resuming vigorous activities.   Recovery after knee replacement is slower.  More time is needed to recover range of motion and gain strength.  

Impact of Joint Replacement on Athletic Performance

How does joint replacement affect athletic performance? Surveys of small numbers of golfers show small increase in handicap and decreased drive distance.  Most golfers do not walk the course after joint replacement, and instead choose to use a golf cart.  Some notice some mild discomfort during and after playing, but a high percentage of golfers  were able to resume playing the same or increased frequency as before their surgery.  There is limited data on return to play of tennis players, however.

Can I Return to Golf and Tennis After Joint Replacement? 

So, can you return to golf and tennis after joint replacement? The answer is yes.  However, the tennis and golf swings do put considerable force on the joints. It may take time to rehabilitate your muscles to allow you to return to the same level of activity you had before your surgery.  Even after joint replacement your new hip or knee may ache or feel stiff after athletic activity.  However most golfers and tennis players indicate that they are able to continue to enjoy their sports following joint replacement.  If you routinely participate in sporting activities after joint replacement, it is usually recommended that you have an X-ray every 5 years to ensure that there has been no premature wear of the joint. 

What is Arthritis?

Posted on May 19, 2015.

By: Kathleen A. Hogan, MD

Today I’d like to answer the question, What is arthritis? One of my patients recently expressed concern that her primary care physician had diagnosed her with “degenerative joint disease.” She was worried that this disease was spreading throughout her body causing arthritis in all of her joints, and wondered what she could do to cure it. Unlike the flu, degenerative joint disease is not contagious, nor does it spread like a cancer throughout the body. It is a term to describe arthritis. Arthritis is the result of damage to the articular cartilage of a joint. Normal articular cartilage is smooth, however damage to the cartilage creates small “potholes” and exposes the underlying bone. Articular cartilage functions in a way which is similar to how the sole of your shoe protects your foot. Wear of the sole of your shoes will increase pressure on your foot, causing pain especially with prolonged walking. Likewise, damage to articular cartilage causes pain and swelling in the joints.

Causes of Arthritis

There are many causes of arthritis. Osteoarthritis is a general term which describes arthritis which has no clear cause other than everyday wear and tear on the joints.This is the most common type of arthritis. Anatomic and genetic factors may play a role in why some people get arthritis. Excessive body weight increases the risk of knee arthritis but not hip arthritis. Traumatic damage to the joint as a result of fractures, ligament injuries, or chronic joint instability also result in arthritis. An infection in the joint fluid can also increase your risk of developing arthritis, and for this reason septic joints often require emergent surgery. Having osteoarthritis in one joint does not necessarily increase the risk of arthritis in other joints.

Conditions That Affect the Articular Cartilage


Some medical conditions can affect the articular cartilage in multiple joints. Rheumatoid arthritis, for example, causes a severe inflammatory response which can affect every joint. Gout results in crystals that form in the joint fluid and promote a painful inflammatory response, which can damage cartilage in many joints. In these cases, medications can be given which minimize pain and inflammation, while potentially decreasing the risk of arthritis.

How is Arthritis Treated?


 Typically, anti-inflammatory medications such as Ibuprofen, Advil, Voltaren, Meloxicam, or Celebrex are used initially.These medications can reduce pain and swelling. These medications should be taken with caution as there can be serious side effects such as ulcers, and kidney dysfunction.Tylenol is an excellent pain reliever but can not be taken by patients with liver disease. Narcotic pain medications such as Percocet and Vicodin should not be used for chronic arthritis pain. Ice is recommended to reduce inflammation and swelling, while heat is recommended to help warm up the joint before activity. Bio-freeze and topical anti-inflammatories can also help with pain. Physical therapy is often recommended as  strengthening the muscles around arthritic joints helps to reduce pressure on the joint. For lower extremity arthritis, using a cane (in the hand opposite the arthritic joint) can help to take some of the pressure off the joint and relieve pain. Braces can sometimes be helpful as well. Steroid injections are frequently very successful in reducing pain and swelling.

Options if Pain Persists


If pain persists despite these treatments, some joints can be replaced (hips, knees, ankles, shoulders, wrist, fingers) or fused (spine, ankle, wrist, fingers). These surgeries are very successful in removing pain and restoring ones ability to participate in activities. However surgery should be considered only when all other treatments fail.


Do you have arthritis? If your joints keep you from doing the activities you enjoy, consider scheduling a visit with an orthopedic surgeon to be evaluated and treated. 

What is the Cause of My Hip Pain?

Posted on May 12, 2015.

By: Kathleen A. Hogan, MD

Your hip is hurting. Walking, sleeping, everything seems to cause your hip to hurt. The pain must be coming from your hip joint, correct? Perhaps. Sometimes it can be surprisingly difficult to determine what joint is the primary source of pain.  Hip arthritis can cause back, hip, and knee pain. Arthritis of the spine can cause back, hip, and leg pain. If X-rays show arthritis in multiple areas, how can your physician determine the primary source of pain?

The first step is to pay attention to your symptoms so that you can describe them accurately to your doctor. When do you hurt? All the time or just when you are walking?  Where do you feel pain? Is it down the leg, in the groin, or on the outside of the hip? Do you have numbness or pins and needles in your legs?   Is the pain better when you walk with a shopping cart in the grocery store? Does the pain start after you walk a specific distance? These are some questions that your doctor may ask to help to determine where your pain is originating from.  

Causes of Hip Pain

What are some causes of hip pain? Pain from hip arthritis is typically located in the groin and may radiate down to the knee.  Some patients have limited motion of the hips with difficulty putting on shoes and socks, and pain that is predominately in the back or in the knee.   Bursitis around the hip can cause pain on the outside of the hip.  It can be very painful to sleep on ones side.  Sometimes the hip may feel like it is going to give out.  Disc herniations in the back can cause pain that radiates down the leg. Depending on the location of the disc herniation, the pain may go into the groin. Spinal stenosis is caused by the narrowing of the space for the nerves in the back due to arthritic changes.  This can cause pain that radiates down both legs. Pain from spinal stenosis is often improved when you lean forward (on a shopping cart, for example).  Back and hip pain can often be caused by muscle weakness or tightness as well.  

Diagnosing Hip Pain

In order to help determine the cause of your pain, your doctor may choose to order X-rays of your hip and/or back.  X-rays are very good at showing bony abnormalities and for the diagnosis of arthritis.  Sometimes an MRI can also give helpful information.  MRI’s will show disc herniations, tendon injuries, and bony abnormalities such as avascular necrosis.  However, an abnormal finding on an X-ray or MRI may or may not be the source of your pain.  Cortisone injections can provide pain relief and also help determine if the abnormalities on the imaging studies are causing your pain. Physical therapy is often helpful if muscle imbalance or weakness is contributing to the pain.  Not all pain is arthritis and not all patients with arthritis require surgery.  If you are having hip pain that keeps you from doing things you enjoy, talk to your doctor and get evaluated to find out where the pain is really coming from and what can be done to get you back to doing the activities you enjoy.